Methods proposed for monitoring the implementation of evidence-based research: a cross-sectional study.

OBJECTIVES: Evidence-based research (EBR) is the systematic and transparent use of prior research to inform a new study so that it answers questions that matter in a valid, efficient, and accessible manner. This study surveyed experts about existing (e.g., citation analysis) and new methods for monitoring EBR and collected ideas about implementing these methods. STUDY DESIGN AND SETTING: We conducted a cross-sectional study via an online survey between November 2022 and March 2023. Participants were experts from the fields of evidence synthesis and research methodology in health research. Open-ended questions were coded by recurring themes; descriptive statistics were used for quantitative questions. RESULTS: Twenty-eight expert participants suggested that citation analysis should be supplemented with content evaluation (not just what is cited but also in which context), content expert involvement, and assessment of the quality of cited systematic reviews. They also suggested that citation analysis could be facilitated with automation tools. They emphasized that EBR monitoring should be conducted by ethics committees and funding bodies before the research starts. Challenges identified for EBR implementation monitoring were resource constraints and clarity on responsibility for EBR monitoring. CONCLUSION: Ideas proposed in this study for monitoring the implementation of EBR can be used to refine methods and define responsibility but should be further explored in terms of feasibility and acceptability. Different methods may be needed to determine if the use of EBR is improving over time.

The effectiveness of oral bovine lactoferrin compared to iron supplementation in patients with a low hemoglobin profile: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Patients with a low serum blood hemoglobin concentration suffer from a pathologic state that contributes significantly to morbidity and mortality figures worldwide. Oral iron supplementation, the most common method of treatment, is reported to have poor patient adherence, due to its unwanted side effects. Lactoferrin is a globular glycoprotein of the transferrin family that has shown promising results in patients with a low hemoglobin profile. This systematic review and meta-analysis of randomized clinical trials explore its effect on blood hemoglobin compared to conventional iron preparations. METHODS: We followed the PRISMA Guidelines for reporting systematic reviews and meta-analyses. A systematic search was conducted in electronic databases (PubMed, CINAHL, Scopus, and Cochrane) from inception to June 2022. Meta-analysis was performed on studies where the primary outcome was the mean Hb concentration, comparing lactoferrin to ferrous sulfate subgroups. We assessed the methodological quality of the trials using the Jadad scoring scale. RESULTS: Nineteen trials published between 2006 and 2022 met the eligibility criteria. It has been found that the levels of Hb concentration in different populations with varying health conditions undergo a moderate to significant change after treatment with all types of trialed interventions, including both iron and lactoferrin treatment, in both the intervention group and the comparison group. Most of the studies report that LF showed a statistically significant increase in Hb concentration levels, compared to those in the iron group. The meta-analysis included seven trials comparing the effectiveness of lactoferrin to ferrous sulfate for patients with low Hb concentration. The analysis showed a statistically significant increase in Hb levels in the oral bovine lactoferrin group compared to ferrous sulfate (SMD -0.81, 95% CI: -1.21, -0.42, p < 0.0001, I2 = 95.8%, P heterogeneity < 0.001). CONCLUSIONS: Lactoferrin is an effective intervention at doses of 100-250 ng/day, for patients with a low Hb concentration. As a safer option and with high compliance evidence, lactoferrin can serve as an iron replacement treatment for patients who may be experiencing adverse side effects due to iron intake.

Prognostic Factors Influencing Survival in Ovarian Cancer Patients: A 10-Year Retrospective Study.

OBJECTIVE: To analyze the factors associated with overall survival (OS) and progression-free survival (PFS) in patients with ovarian cancer in Cyprus. METHODS: We retrospectively analyzed data from patients with histologically confirmed epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC). RESULTS: A total of 106 women diagnosed with ovarian cancer were included, with a median age at diagnosis of 58 years. The Kaplan-Meier survival analysis showed a median OS of 41 months (95% C.I = 36.9, 45.1), and the FIGO stage (p < 0.001), type of surgery (p < 0.001) and performance status (p < 0.001) were identified as statistically significant prognostic factors for OS. PFS analysis revealed the FIGO stage (p = 0.006) and the performance status (p < 0.001) as significant prognostic factors. Additionally, a Cox regression analysis for median OS was performed for patients with high-grade serous carcinoma, identifying the performance status, FIGO stage, and type of surgery as prognostic factors in univariate analysis. However, in the subsequent multivariate analysis, the performance status and the FIGO stage were confirmed to be the only statistically significant prognostic factors for OS (p < 0.05). CONCLUSIONS: This study confirms that the FIGO stage, performance status, and surgery type were considered as prognostic factors for OS in ovarian cancer.

The association between dietary intake of macro- and micronutrients and multimorbidity: a cross-sectional study in Cyprus.

Research on the link between diet and multimorbidity is scarce, despite significant studies investigating the relationship between diet and individual chronic conditions. This study examines the association of dietary intake of macro- and micronutrients with multimorbidity in Cyprus's adult population. It was conducted as a cross-sectional study, with data collected using a standardised questionnaire between May 2018 and June 2019. The questionnaire included sociodemographic information, anthropometrics, medical history, dietary habits, sleep quality, smoking habits, and physical activity. The participants were selected using a stratified sampling method from adults residing in the five government-controlled municipalities of the Republic of Cyprus. The study included 1137 adults with a mean age of 40⋅8 years, of whom 26 % had multimorbidity. Individuals with multimorbidity consumed higher levels of sodium (P = 0⋅009) and vitamin A (P = 0⋅010) compared to those without multimorbidity. Additionally, higher fibre and sodium intake were also observed in individuals with at least one chronic disease of the circulatory system or endocrine system, compared to those with no chronic diseases in these systems (P < 0⋅05). Logistic regression models revealed that individuals with ≥2 chronic diseases compared to 0 or 1 chronic disease had higher fat intake (OR = 1⋅06, 95 % CI: 1⋅02, 1⋅10), higher iron intake (OR = 1⋅05, 95 % CI: 1⋅01, 1⋅09), lower mono-unsaturated fat intake (OR = 0⋅91, 95 % CI: 0⋅86, 0⋅96), and lower zinc intake (OR = 0⋅98, 95 % CI: 0⋅96, 0⋅99). Future research should replicate these results to further explore the intricate relationships between nutrient intake and multimorbidity. Our study's findings suggest that specific dietary components may contribute to preventing and managing multimorbidity.

Assessing awareness of long-term health risks among women with a history of preeclampsia: a cross-sectional study.

Pregnancy complications, such as hypertensive disorders, present a substantial global public health challenge, with significant long-term implications for maternal and offspring health. This cross-sectional study aims to determine the level of awareness regarding long-term health risks among women who experienced preeclampsia during pregnancy in Cyprus and Greece. The study participants included adult women with a history of preeclampsia, while women with normal pregnancies were used as the comparison group. Data collection took place between June 2021 and February 2022, utilizing an online, self-administered questionnaire. The study included 355 women, with 139 (39.2%) in the preeclampsia group and 216 (60.8%) in the comparison group. Findings revealed that more than half of the women with prior preeclampsia (55.4%) were not aware of hypertensive disorders that can occur during pregnancy before their diagnosis, and a similar percentage (45.2%) had not received information about the long-term health risks following their diagnosis. Remarkably, only 3 participants (4.7%) with a history of preeclampsia were aware of the risk of developing cardiovascular diseases. There were no statistically significant differences between the preeclampsia and the comparison group regarding their concerns about long-term health risks, frequency of health checks, perceptions of factors influencing cardiovascular disease development, and doctor communication about different health topics, except from hypertension or high blood pressure. The study underscores the low level of awareness of long-term health risks among women with prior preeclampsia in Cyprus and Greece. This emphasizes the importance of implementing public health programs aimed at promoting cardiovascular risk assessment and effective management, both for clinicians and women with have experienced preeclampsia.

Prevalence and sociodemographic determinants of selected noncommunicable diseases among the general population of Cyprus: A large population-based cross-sectional study.

Background: Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide. The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs. Methods: A cross-sectional study was conducted using stratified sampling. Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire. The diseases were classified using the 10th revision of the International Classification of Diseases (ICD-10). Results: In total, 1140 individuals participated in the study, among whom 590 (51.7%) had at least one chronic disease. The most prevalent NCDs were hyperlipidemia (17.4%), hypertension (12.9%), and thyroid diseases (8.4%). We identified more males than females with hyperlipidemia aged 25-44 years old and >65 years old (p = 0.024), more males compared to females with hypertension (p = 0.001) and more females compared to males with thyroid diseases (p < 0.001). Individuals with hypertension and hyperlipidemia were more likely to be married, to have completed a higher education, and to have a high annual income. Discussion: In Cyprus, the majority of the general population had at least one NCD. Hyperlipidemia, hypertension, and thyroid disease are relatively common, even at younger ages, highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.

Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease.

Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.

Factors associated with perceived fear of future pandemics and/or epidemics: a cross-sectional study in Cyprus.

This study aims to understand the levels of fear experienced by individuals regarding future pandemics and/or epidemics among the general population of Cyprus and comprehensively examine the diverse factors that influence this perceived fear. The cross-sectional study was conducted from October 1st, 2022, to February 19th, 2023. A proportionate quota sampling method was used for the recruitment, by recruiting a fixed number of participants from each age group, sex, and place of residence. The study collected information on sociodemographic and health-related characteristics, health literacy, trust, COVID-19 vaccination information, and perceived fear of future epidemics and/or pandemics using a self-administered questionnaire. The survey included 1075 participants, with 53.7% of them reporting fear of future pandemics. Logistic regression analysis revealed that women (OR = 2.37, 95% CI 1.78, 3.16) and individuals vaccinated against COVID-19 (OR = 1.57, 95% CI 1.02, 2.43) were significantly more likely to experience fear of future pandemics. Moreover, higher levels of trust (OR = 1.04, 95% CI 1.02, 1.06) and higher health literacy (OR = 1.05, 95% CI 1.03, 1.08) were associated with an increased likelihood of fearing future pandemics. Conversely, unemployment (OR = 0.30, 95% CI 0.13, 0.65) and having a postgraduate education decreased the likelihood of fearing future pandemics (OR = 0.56, 95% CI 0.34, 0.90). The linear regression model revealed that older age (ß = - 0.10, 95% CI - 0.14, - 0.05) was negatively associated with a higher score of fear regarding future pandemics. Conversely, being in a vulnerable group (ß = 2.02, 95% CI 0.75, 3.28) and having at least one chronic disease (ß = 1.76, 95% CI 0.68, 2.84) showed positive associations with increased fear of future epidemics and/or pandemics. The findings emphasize the need for relevant authorities to prioritize mental health and disseminate information in a manner that avoids spreading fear and panic, particularly among vulnerable population groups.

Multimorbidity and food insecurity in adults: A systematic review and meta-analysis.

Food insecurity is one of the main factors affecting multimorbidity. Previous studies have shown that food insecurity may lead to multimorbidity due to person's inability to consume nutritious diet. However, considering that multimorbidity may cause work-related disabilities and an unstable income, others support the possible effect that multimorbidity has on food insecurity. The purpose of this systematic review and meta-analysis is to examine the relationship between food insecurity and multimorbidity in adults. A systematic literature review of studies was performed using the PubMed, EBSCO and SCOPUS for all articles including adults ≥ 18-year-old with multimorbidity living in developed countries published from August 5th until December 7th 2022. Meta-analysis was performed considering results from the fully adjusted model. The methodological quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. This systematic review was not registered. This research received no specific grant from any funding agency. Four cross-sectional studies involving 45,404 participants were included in order to investigate the possible impact that food insecurity has on multimorbidity. The study findings showed an increased probability of multimorbidity 1.55 (95% CI:1.31-1.79, p<0.001, I2 = 44.1%) among people with food insecurity. Conversely, three of the included studies, involving 81,080 participants concluded that people with multimorbidity, have 2.58 (95% CI: 1.66-3.49, p<0.001, I2 = 89.7%) times higher odds to present food insecurity. This systematic review and meta-analysis provide evidence of a reverse association between food insecurity and multimorbidity. Further cross-sectional studies must be conducted in order to elucidate the association between multimorbidity and food insecurity across age groups and between the two genders.

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment.

BACKGROUND: Cognitive impairment is common in patients with chronic kidney disease (CKD), and early intervention may prevent the progression of this condition. METHODS: Here, we review interventions for the complications of CKD (anemia, secondary hyperparathyroidism, metabolic acidosis, harmful effects of dialysis, the accumulation of uremic toxins) and for prevention of vascular events, interventions that may potentially be protective against cognitive impairment. Furthermore, we discuss nonpharmacological and pharmacological methods to prevent cognitive impairment and/or minimize the latter's impact on CKD patients' daily lives. RESULTS: A particular attention on kidney function assessment is suggested during work-up for cognitive impairment. Different approaches are promising to reduce cognitive burden in patients with CKD but the availabe dedicated data are scarce. CONCLUSIONS: There is a need for studies assessing the effect of interventions on the cognitive function of patients with CKD.

The Effect of Mastic Chios Supplementation in Inflammatory Bowel Disease: A Systematic Literature Review.

Mastic Chios is a natural treasure of Greece that offers many potential benefits in various disorders due its antioxidant and anti-inflammatory properties. This systematic review aimed to investigate the effect of Mastic Chios supplementation in inflammatory bowel disease (IBD). A systematic search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across PubMed/Medline and EBSCO databases until February 2023. Clinical studies that examined individuals of any age being diagnosed with IBD as well as preclinical studies using animals with experimental colitis were considered eligible for inclusion. Studies included were assessed for methodological quality. Eight articles were eligible for inclusion, with seven conducted in Greece and one study in Iran. Most of the studies were randomized controlled trials (RCTs) and one was a pilot study. The intervention period varied between 3 and 7 days for animal studies and 4 weeks to 6 months for human studies. Mastic Chios supplementation varied between 2.2 and 2.8 g/day for clinical studies. The majority of studies concluded that Mastic Chios has significant antioxidant and inflammatory effects in IBD. This systematic review suggests that Mastic Chios may have a positive effect on the regulation and management of IBD. However, more high-quality clinical trials are needed to provide reliable and concrete conclusions about the effectiveness of Mastic Chios in this population. Such studies will further support the use of Mastic Chios as a reliable therapeutic option for IBD.

Decision-making on childhood vaccination against COVID-19 by nurses in Cyprus: A cross-sectional online survey.

Individuals with high health literacy, such as healthcare workers, are expected to appreciate vaccination benefits and ensure the vaccination of their children. The objective of this study was to examine the factors influencing nurses' decision to vaccinate their children against COVID-19. An online cross-sectional study was conducted in December 2020 (8th-28th), before COVID-19 vaccine availability in Cyprus, and employed an anonymous self-administered survey with questions related to socio-demographic characteristics, general vaccine knowledge, and COVID-19 vaccination. Three hundred five nurses with at least one minor child completed the online questionnaire. A small proportion of participants (15.2%) planned to get their children vaccinated against COVID-19. Interestingly, a higher level of vaccination knowledge score was linked with increased likelihood of vaccination intention (OR = 1.35, 95% CI:1.08-1.68), which remained statistically significant after adjusting for age and gender (OR = 1.33, 95% CI:1.06-1.66), socioeconomic (OR = 1.35, 95% CI:1.07-1.70), and demographic characteristics (OR = 1.38, 95% CI:1.07-1.77). Specific characteristics such as older age and being married/in cohabitation status were linked to higher odds of accepting the childhood vaccination against COVID-19. Acceptance of childhood vaccination against COVID-19 is linked with nurses' vaccination knowledge, therefore, public health authorities may focus on educational campaigns to promote childhood vaccination.

Congenital Cytomegalovirus Infection and Ophthalmological Disorders: A Systematic Review.

Congenital cytomegalovirus (CMV) infection is the most common congenital viral infection and can be a major cause of neurodevelopmental disabilities, including various ocular disorders in infants and young children. This review summarizes the evidence on the association between congenital CMV infection and the type and frequency of ocular disorders. A systematic search was conducted across PubMed and Cochrane Library from inception through December 2021 to identify studies examining the association between congenital CMV infection and the occurrence of ocular disorders in children born with this infection. Seventeen articles were identified. A total of 306 ocular disorders were identified in 977 children, with 45 of them (4.6%) being related to cases of chorioretinitis. A total of 259 of the 306 (84.6%) ocular disorders occurred in symptomatic children. Four studies did not report the number of children with ophthalmological disorders. The remaining 13 studies reporting this parameter included 666 children, of whom 85 had ophthalmological disorders (12.7%). Vision was tested in 556 children and visual impairement was detected in 91 of them (16.3%). Given the high prevalence of congenital CMV infection and the frequent occurrence of ocular disorders, the question that arises is whether there should be worldwide screening for congenital CMV infection so that both symptomatic and asymptomatic children can be detected in time to reduce the burden of the disease and its complications. [J Pediatr Ophthalmol Strabismus. 2023;60(2):86-94.].

Access to Healthcare Services and Essential Medicines in GREEK Migrant Camps: an Online Cross-Sectional Study.

During the last years, Greece has become the entry point of a high number of migrants and asylum seekers. The aim of this study was to assess the access to selected fields of primary healthcare, to emergency medical care, secondary healthcare and essential medicines among populations living in reception, temporary accommodation, and detention centres (migrant camps) in Greece. An online cross-sectional survey was conducted based on a self-administered questionnaire. Participants included indviduals working or volunteering in migrant camps in Greece. 64 individuals participated in this study. The most common health problem among people residing in migrant camps was mental health conditions. The access to each field of primary healthcare was assessed as minimum to non-existent by most of the participants. 47.2% assessed the access to emergency medical care as minimum/non-satisfactory, while 60.8% assessed the access to secondary healthcare as minimum to non-existent. Most participants assessed the access to all the medicines categories as minimum or moderate. Access to both primary and secondary health was given a lower grade in the East-Aegean islands compared to the mainland. Major health inequalities among populations residing in Greek migrant camps were highlighted in this study. A change in the current migration policies of Greece and the European Union is urgently needed.

Determinants of COVID-19 vaccine uptake among healthcare professionals and the general population in Cyprus: A web-based cross-sectional survey.

OBJECTIVE: This study aims to examine the factors influencing COVID-19 vaccine uptake among healthcare professionals (HCPs) and the general population in Cyprus. METHODS: A web-based cross-sectional study was conducted (November 2021-January 2022), using a self-administered, anonymous questionnaire to collect information covering a wide range of potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information and general vaccination knowledge. RESULTS: A total of 2582 participants completed the survey. Overall, 53.5% of participants representing the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by 1 year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00, 1.03, p= 0.035). In addition, participants among the general population with increased trust in national healthcare authorities' guidelines (OR = 3.96, 95% CI: 3.41, 4.61), and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05, 1.18) were significantly more likely to be vaccinated, while those who had underage children living in the household were significantly less likely to be vaccinated against COVID-19 (OR = 0.68, 95% CI: 0.50, 0.91). Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01, 3.59), and those who reported increased trust in national healthcare authorities' guidelines (OR = 5.38, 95% CI: 3.65, 7.95) were significantly more likely to be vaccinated. CONCLUSION: Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavourable scenarios, such as future pandemics.

Attitudes and perceptions of mothers towards childhood vaccination in Greece: lessons to improve the childhood COVID-19 vaccination acceptance.

Background: Maternal attitudes and beliefs have been shown to influence childhood vaccination coverage, resulting in under-vaccination, non-vaccination, and vaccination delay. This study aimed to investigate the mothers' attitudes and perceptions about vaccination for their children in Greece. Methods: This was an online cross-sectional study, conducted from 4 April to 8 June 2020. A self-administered questionnaire was used to collect information about mothers' and their children's socio-demographic characteristics, previous vaccination behavior, and mothers' attitudes and perceptions about childhood vaccination. Participants included adult mothers with at least one minor child. Results: One thousand eight hundred eighty-five mothers participated, with the majority (91.7%) believing in the usefulness of vaccines and that vaccines protect children from serious and life-threatening diseases. A larger percentage of mothers with higher educational attainment agreed/absolutely agreed that all vaccinations provided by the National Vaccination Program must be offered to their children (91.6%) (p = 0.02) and that vaccines protect children from serious and life-threatening diseases (92.9%) (p = 0.01). Significant more married/in cohabitation and not single-parent mothers agreed that vaccines are safe (53.5% and 53.4%, respectively). There were also several significant associations between maternal attitudes toward childhood vaccination and previous maternal vaccination practices [(e.g., adherence to recommended vaccination dosages (all p-values < 0.01), vaccination delays (all p-values < 0.05), and vaccination during pregnancy (all p-values < 0.01)]. Conclusion: Maternal attitudes and perceptions toward childhood vaccination are significantly influenced by sociodemographic factors and maternal vaccination practices. Revealing those is essential for public health officials in developing future strategies to improve childhood vaccination coverage and acceptance of new vaccines such as the COVID-19 vaccine.

Dual Trigger with Gonadotropin Releasing Hormone Agonist and Human Chorionic Gonadotropin of Fresh Autologous Cycles in High Responders: A Systematic Review.

Background: The purpose of the current study was to investigate the effect of co-administration of human chorionic gonadotropin (hCG) with gonadotropin releasing hormone agonist (GnRH-a) trigger (dual trigger) in high responders for fresh autologous cycles in order to investigate the pregnancy outcomes and rates of ovarian hyperstimulation syndrome (OHSS) in comparison to GnRH-a trigger alone. Methods: A systematic search was performed in PubMed and Ovid MEDLINE from inception through February 2020. The included materials were case-control, cohort and, cross-sectional studies as well as clinical trials in which the outcomes of dual trigger with GnRH-a were compared for final oocyte maturation in high responders undergoing GnRH-ant cycles. Results: Five retrospective studies were included for this review. Three of the studies showed that the use of dual trigger versus GnRH-a trigger resulted in no statistically significant difference in rates of OHSS while achieving a statistically significant difference in favor of the dual trigger group in ongoing pregnancy rates, early pregnancy loss, and fertilization rates. Conclusion: Currently, there is insufficient evidence to support improved clinical pregnancy rate, fertilization rate, live birth rate, and early pregnancy loss rate by the use of dual trigger versus GnRH-a trigger. Larger double-blind clinical studies are required to properly evaluate the efficacy of this protocol for use in high responders.

Ovulation induction techniques in women with polycystic ovary syndrome.

Anovulation is very common and has several different clinical manifestations, including amenorrhea, oligomenorrhea and abnormal uterine bleeding. Various mechanisms can cause anovulation. The clinical consequences and commonest chronic anovulatory disorder, polycystic ovary syndrome (PCOS), has a prevalence that ranges between 6 to 10% of the global population. While multiple causes can eventually result in PCOS, various methods have been described in the literature for its management, often without ascertaining the underlying cause. Ovulation Induction (OI) is a group of techniques that is used in women with PCOS who are looking to conceive and are unbale to do so with natural means. This narrative review presents a summary of the current evidence and available techniques for OI in women with PCOS, highlighting their performance and applicability.

Vitamin D Deficiency as a Possible Cause of Type 1 Diabetes in Children and Adolescents up to 15 Years Old: A Systematic Review.

OBJECTIVE: To evaluate vitamin D ((25OH)D levels) deficiency as a possible cause in the development of DT1 in children and adolescents aged 0-15. METHODS: We searched PubMed/ Medline, EBSCO, and Cochrane Library to identify potentially eligible articles that examine whether low serum 25(OH)D levels are associated with subsequent development of DT1. All type of research designs, including randomized and non-randomized controlled trials, prospective and retrospective cohort studies, case- control and cross-sectional studies with subjects aged ≤15 years old were consider for inclusion. RESULTS: Seven original studies met the entry criteria. Most of these studies found up to 50% lower levels of vitamin D in children with DT1 compared to control group and a significant positive association between vitamin D levels and of the risk of developing DT1. Results of quality assessment demonstrated moderate to high quality of all the studies included. CONCLUSIONS: Vitamin D deficiency may be a possible cause in the development of DT1 in the early years of life and particularly in children with genetic predisposition, whilst the deficiency of vitamin D is a very common occurrence in patients with DT1. Further long-term studies on children are required to determine the role of vitamin D on DT1.